1831335942 NPI number — THOMAS J. GILLIGAN, PH.D., P.C.

Table of content: (NPI 1831335942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831335942 NPI number — THOMAS J. GILLIGAN, PH.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS J. GILLIGAN, PH.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831335942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
706 MAPLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68347-2110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-781-1122
Provider Business Mailing Address Fax Number:
402-781-1122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8101 O ST
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-2646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-488-1032
Provider Business Practice Location Address Fax Number:
402-484-8545
Provider Enumeration Date:
12/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GILLIGAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-488-1032

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  171 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100025642000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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